Expansion of Medicaid is vital to keep health costs in check: Your Turn

If Gov. John Kasich decides to turn down federal funding to expand the number of Medicaid beneficiaries to include adults earning up to 133 percent of federal poverty, the ripple effect will be felt by every Ohio resident.

To states choosing to expand Medicaid, the Affordable Care Act provides federal subsidies to single adults earning between $11,170 and $14,856 for buying health insurance. But the refusal to expand Medicaid would leave the poorest of the poor in our state without any coverage — a single adult in Ohio could not earn more than $10,053 and qualify for Medicaid.

For 20 years the American Academy of Family Physicians (of which the Ohio Academy of Family Physicians is a constituent chapter) has supported health care coverage for all. Although the ACA Medicaid expansion provisions are not perfect, they are a major step in the right direction and an important improvement over the status quo for working poor Ohio residents.

Failure to expand Medicaid doesn’t simply deny coverage to the most vulnerable Americans. It creates an economic wave that will wash over patients, hospitals and ultimately, everyone in Ohio both insured and uninsured.

Research consistently shows that people who have health insurance coverage, whether public or private, are more likely to have a usual source of care, better overall health and better control of chronic conditions.

Studies also demonstrate that people without insurance skip or delay needed preventive services and postpone care during early, easily treated stages of an illness. By the time these people seek help, they require much more intensive — and expensive — care that could have been avoided. Worse, they are less likely to have the resources to pay for that more expensive care.

As family physicians, we see this scenario play out daily. Each week, AAFP members provide free care or reduce their fees for an average of eight patients who don’t have insurance or the financial resources to pay for their care.

Our members’ experience is the foundation for the AAFP’s 20-year policy advocating for health care for all. It’s also the reason why we urge Gov. Kasich to participate in this program that will pay 100 percent of the cost for Ohio to expand Medicaid to 670,992 Ohioans who would qualify.

But, the poorest of the poor are not alone in feeling repercussions of Ohio’s failure to expand Medicaid. Safety net hospitals — which provide care to the uninsured and underinsured — would also take a serious hit.

In anticipation of expanded Medicaid coverage to pay for working poor adults’ care, the ACA reduces what is known as “disproportionate share” funding. This was money that helped compensate hospitals for the free care they provided to patients who could not pay their hospital bills. Safety net hospitals face a darkening financial future in the wake of reduced disproportionate share funding and continued need for care from uninsured, low-income patients who don’t have access to expanded Medicaid coverage.

What this means is that all Ohio residents will pay if Ohio decides not to expand Medicaid — albeit indirectly — for the care of Ohio’s 670,992 uninsured.

Without Medicaid expansion, hospitals and other health care providers will face continued need among the uninsured, struggle with reduced support for the free care they provide and be forced to distribute their growing financial losses to their paying customers — you and your insurance company.

It means your insurer will likely raise premiums to make up for the higher charges it receives. It means your employer — or your family, if you have an individual account — will reassess the financial viability of continuing to buy health insurance.

For many, the decision could be “drop the coverage.” And, we know where that decision goes: an increase in the number of uninsured Ohio residents, which, in turn, puts undue financial strain back on our patients, providers, and ultimately the state to cover the uninsured.

A decision to refuse to increase coverage for Medicaid beneficiaries to 133 percent of poverty — despite 100 percent federal financing — is a short-sighted highly politicized decision that will have a long-term, negative effect on all Ohio residents. We urge Gov. Kasich to make the right decision.

Willins, a family physician in Westlake, is president of the Ohio Academy of Family Physicians.

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